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Old 10-28-2012, 09:13 PM   #1
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Help understanding lab results..

Dosage was:

175 synthroid
25 cytomel

JUNE- Lab results were:

Free T3 = 5.1 (3.5-6.5)
TSH = 1.63 (.35-5.00)
Free T4 = 16 (9-23)

Looks perfectly in range but feel crazy, psoriasis out of control. Cannot sleep. Extreme hip and lower back pain. Ears ringing...

In August I started reducing my strength by splitting the cytomel- I took 12.5 with 175 of synthroid, my lab reports are as follows (4 weeks later):

Free T3 = 5.0 (3.5-6.5)
TSH = 1.93 (.35-5.00)
Free T4 = 15 (9-23)

Notice little change- nails slightly better.. Still can't sleep.. Lower back and hip pain is gone...

Sept, I reduce further. 125 synthroid, 12.5 cytomel (6 weeks later):

Free T3 = 5.7 (3.5-6.5)
TSH = 8.11 (.35-5.00) ***HI***
Free T4 = 15 (9-23)

Feel much better- worried that I may feel some brain fog. Nails are feeling and looking much better. If I can fall asleep, I sleep very well- can actually sleep in some mornings!

Not knowing how this all works, I find it interesting my FT3 actually increased with me lowering my dose. I have now started a dose of 125 synthroid and 25 cytomel (seems to be holding the brain fog off) and will be having another blood test in 6 weeks. Could this adjustment bring my TSH level down? I'm feeling synthroid has been a major issue with my other health issues.

Thanks for your time and input.

 
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Old 10-29-2012, 09:14 AM   #2
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Re: Help understanding lab results..

You're the first person I've ever seen who takes Cytomel or natural thyroid who's ever had normal-range TSH. Almost always, a T3 med will suppress TSH when optimally dosed. Also, your dose of 25 mcgs is quite high. It's the rough equivalent of 200 mcgs of Synthroid, which when added to that adds up to a large amount of replacement hormone.

Since your TSH is not responding typically to the Cytomel, and since your FTs don't appear either low or excessive despite where TSH sits, I'm really unsure what to make of it all. Sorry I can't help more.
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Old 10-29-2012, 12:15 PM   #3
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Re: Help understanding lab results..

CloudRunner - congratulations to whoever got you to lower your doses - you are going in exactly the right direction. The biggest clue is that you say "YOU ARE FEELING MUCH BETTER"!

Your last TSH reading is odd - but ignore it - it's the FT3 and FT4 that count. TSH takes a lot longer to stabilize and I think if you were to repeat the labs the TSH would be a lot different.

Personally, I consider the median value (50th percentile) to be normal, rather than the reference ranges which are the 2.5 and 97.5 percentiles. So your FT4 reading of 15 is 12% higher than the median of 13.4. Your FT3 of 5.7 is 28% higher than the median value of 4.44.

It is unfortunate that you do not have any Reverse T3 labs. I think they would have been very high, because the body gets rid of excess T4 (synthroid) by converting it to RT3. This is not good because RT3 inhibits the action of your T3 (prevents T3 from doing the jobs it is supposed to do in the cells of your body) and can cause you to have HYPO symptoms.

My assessment of your last labs would have been: your FT3 is well above normal - you do not need more cytomel. Your FT4 is above normal and is contributing to the elevated FT3 and also is being converted to RT3 - which is not good, as I explained above. I would have gone to 100 +12.5 or 88 + 12.5. (have a look at the post of Heckofagal on this board. Her #2 dated 07-08-2012, 02:30 PM. On 88 + 5 her readings fell near the medians.)

Please try to get a RT3 on your next set of labs. If your reading is significantly higher than the median value of 21-22 ng/dL then that is confirmation that you could reduce your synthroid. Remember - when you get near optimized and are feeling good - give the meds a very long time before switching, and rely more on your symptoms than the lab readings.
good luck.

 
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Old 10-30-2012, 10:59 AM   #4
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Re: Help understanding lab results..

Telus and Midwest thank you very, very much for taking the time to help a stranger.

Your help is beyond appreciated!

I started this dosage decrease on my own decision. My finger and toe nails are a mess, I truly believe this is connected.. Including my skin psoriasis. Seeing my social skills suffer and basically my character change. I needed to take this into my own hands. Sooo here I am asking for help.

I did increase my cytomel dose back to 25 for the past two days and now back to 12.5 with my 125 sythroid.
I did question with my Dr about having my T3 and T4 in range and my TSH out- I never did get an answer...
Okay, so I'm staying at this dose (12.5+125) another 4 weeks and seeing the lab reports- I will have them add RT3 to my labs from now on. I do still have trouble falling asleep. My Dr. is a great guy and has given me a blood work card which allows me labs anytime I like.

I am extremely nervous about having any brain fog appear. My work is directly influenced by my mental performance and is always being monitored and assessed- can be very, very stressful. Especially experiencing zombie mode while I first started this career and nearly being washed out because of it. I believe this has led me to these extremely high dosing and these awful side effects... Adding the cytomel was an amazing step forward though.

THANK-YOU
THANK-YOU
THANK-YOU

 
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Old 11-02-2012, 06:12 AM   #5
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Re: Help understanding lab results..

Greetings,

My Dr. has added rT3 to my blood work- I cannot wait to see what has been happening with this level on my next blood test.

I wanted to add that my symptoms of psoriasis and feeling god awful, are seriously diminishing. I'm feeling absolutely amazing compared to just a few weeks ago (which was for the last ten years!)

I hope I'm not jumping the gun here, but after all these years of increasing dosages and feeling worse and worse, the last few months of slowly deceasing have given me a new outlook on life- simply amazing..

I find it mind boggling after seeing numerous Dr's including an endocrinologist that not one was interested in seeing my symptoms as whole......When I couldn't sleep- prescription for sleeping pills, had slight body tremor - prescribed beta blockers, developed psoriasis in nails which slowly extended to my skin and then scalp extremely bad- prescribed tons of steroid shampoos and ointments etc..., brain fog and feeling awful- prescribed more thyroid drugs! The list goes on..

The more I think about this now, It seriously has my head spinning (figuratively speaking of course). It's beyond apparent that I've been way to high of dosage for way too long, and which I'm assuming for now- excessive rT3's. I'm extremely concerned what damage this has caused me. I was having some severe lower back pain before I started this slow dosage decrease, including some hip pain. Over the years I would have episodes where my thyroid would be a throbbing ache- which led to ultrasounds performed by a very talented close friend of mine. She found two nodules but said my thyroid is tiny and all shriveled up.

Telus- I don't know your background but your detailed assessment and comments have helped considerably. Thank you...
The more I research the knowledge behind your post, the more it's starting to make sense! Not quickly mind you- but the light bulb has finally lit.

My dosage of 125 synthroid and 12.5 has been going for six weeks and improvements have slowly halted? I've started this week (and for the next 6-8 weeks) taking the same dosage BUT on Saturdays and Wednesdays I'm splitting my 125 synthroid in half- giving me a weekly average of 107 of synthroid.

Suggestions and/or comments are always welcomed - thx fellow posters!

 
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Old 11-02-2012, 11:44 AM   #6
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Re: Help understanding lab results..

Hi Cloudy.
Thanks for the feed-back. I am, like you, a student at the TSH - the Thyroid School of Hardknocks.

This is how it goes: you start taking Synthroid, you're probably hypo, but don't know it. You're hypo so your cholesterol goes up; your doc gives you statins (Lipitor, Cretor, etc). You get muscle and joint pain. Muscle and joint pain are a side effect of hypo. Muscle and joint pain are also the number one side effect of statins; exercise makes it worse. You get lower back and hip pain; your joints don't stay in place; you go to the chiropractor. Chronic aches and pains makes your blood pressure go up; your doc gives you blood pressure pills. And so on, and so on until you get lucky and find out this doesn't have to be. You start doing research and find out a lot of things...

Getting back to your plan - I would say it would be better for you to buy some new pills - say 100 mcg. The way you are doing it - your body must react to taking 125 one day, then 62.5 the next. You may not feel it, but obviously this is not normal for your body and it must be very difficult for your internal chemistry to adapt. And why make things more difficult when you can just get new pills?

Another thing that you are going to have to watch for is how long does it take to get rid of the effects of high RT3 - I do not know the answer - I am still working thru that myself. Let's say after 6 weeks your blood test comes back with normal RT3 - from what I find on the net, the residual effects can last longer. This appears to be a grey area. So this has to considered very very carefully before making dose changes. (if you find anything pls let me know).

Here are a few other do's and don't that may seem small, but are important:
1. Do allow time before and after between taking meds and eating. Food seriously affects the absorption of T4. Abbott says 1/2 to 1 hour. I go minimum 1 hour.
2. Do get your blood tests done at the same time of day (say 8-9 am), for consistency of results. Thyroid levels do rise and fall thru the day.
3. Do not take your thyroid meds in the morning prior to your blood test (also for consistency of results). The meds make your levels go up for 3 or 4 hours.

More useful information:
Six weeks is not a long time in the thyroid world. The half-life of Synthroid (T4) is 7 days. Using a formula you can calculate how much has accumulated in your body. For example at 7 days it is only at 50% buildup. At 14 days 75%, 21 days 88%, 28 days 94%, 35 days 97% and 42 days 98%. That's why you need to give it at least 4 weeks before doing lab tests. So considering it takes six weeks to get to 98% and then allow some time for your body to adjust to the full dose - you can see that you have to give it quite a while to see if your symptoms go away, before you make a dose change.

this is my general game plan:
1. get FT4 to near normal (median) by taking T4.
2. get FT3 to near normal (median) by taking T3.
3. give it a good long test period - it takes the body a long time to adjust.
4. if you still have hypothyroid-like symptoms, make sure it isn't something else. Look for anything else that could affect you health (for example low cortisol due to previously being hypothyroid).
4. if after a long time and eliminating all other possibilities you still have hypothyroid symptoms, then increase T3 and T4 in the same proportions as what got you onto the medians, and again give it a good long time.
5. always test FT3, FT4 and RT3.

Median values from the web:
(FT3 and FT4 in pmol/L)
(this FT3:FT4 Ratio only applies when FT3 and FT4 are in pmol/L)
Males under 60
TSH 1.3
FT4 14.2
FT3 4.79
FT3:FT4 Ratio 0.33
RT3 20.1 - 22.7 ng/dL
0.31 - 0.35 nmol/L

Females under 60
TSH 1.41
FT4 13.4
FT3 4.44
FT3:FT4 Ratio 0.32

Last edited by telus; 11-02-2012 at 11:52 AM.

 
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Old 11-05-2012, 05:23 PM   #7
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Re: Help understanding lab results..

Wow- thx Telus! This information highway is simply incredible- thx for your time once again.

Went to my lab today to get

TSH
Free T4
Free T3
and rT3's

Well believe it or not, they no longer offer the rt3 test. I visited 2 other labs in my area with no joy. I live in St Catharines Ontario, I'm keeping my fingers crossed that a lab in Niagara Falls still offers this test (will be calling tomorrow morning). All labs have said that the cost is not covered by OHIP (Ontario Health Insurance Program), and an additional 40 dollars is the charge. No issues with the cost, I just hope I can find this test without having to cross the border.

Strange....

 
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Old 11-05-2012, 08:16 PM   #8
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Re: Help understanding lab results..

Almost same for RT3 in southern Alberta. They will take yer blood at the regular lab, but ya gotta pay 40 bucks.


Keep trying...

Last edited by Administrator; 11-06-2012 at 02:57 AM.

 
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Old 11-15-2012, 04:09 PM   #9
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Re: Help understanding lab results..

Hi everyone,

Well I know it was a little early for another blood exam but I was very curious to see my rT3's- the lab in Niagara Falls offered the test but needs to send it across the border (USA). I completed this blood work on Nov-7th at 10am and after fasting for 12 hours (had cholesterol check as well). I usually take my Synthroid and Cytomel around the 9am. This Day I didn't take my thyroid med till after the blood draw.

Okay, called the Dr. today- Nov-15.

First- the Rt3 part of the test wont be in until another 5-10 days, but the other results have me scratching my head??

TSH 10.5 (0.35-5.00) Still increasing...
FT4 11.0 (9-23)
FT3 4.3 (3.5-6.5)
rT3 .... on its way

Dosage has been the 125 Synthroid and only 62.5 Wed. & Sat. with 12.5 Cytomel everyday. Like mentioned earlier, I know this was a little early for this exam, but have been on this dosage method for 3 weeks.

I feel like I'm packing the pounds on, and as of the last few days I have been feeling very foggy/unmotivated??

What do you think? The other day I was feeling low and I took another half of Cytomel (12.5) around 3pm- It did give a pic me up and made me feel back to normal (I think)... I also have noticed my sleep for the past five days is getting interrupted with waking up a few hours after falling alseep... And feeling wide awake- just like I was experiencing on the high dosage of 175 Synthroid 25 Cytomel...

My psoriasis and nails are still very slowly clearing up though.

Any suggestions? Certainly feel like we're corning this up- I hope!

As always, thx a million in advance for any input and/or advise.

CR

 
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Old 11-21-2012, 02:04 PM   #10
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Re: Help understanding lab results..

Hello fellow readers,

I'm slowly feeling less and less. I feel like I've possibly gone too far the other way? Not sure what to say with the latest lab report? I don't want to make a change before seeing my rT3's- which I'm still patiently waiting for....

I have most certainly gained weight. Can see it on the scale..... I've been keeping up on my exercising but feel like I'm behind the eight ball.
With these latest lab results, would anyone suggest an increase in either T3 or the T4, or keep waiting for the rT3 blood report first? Any chance your still reading this Telus? Your input would also be greatly appreciated.

Thx again my thyroid friends!

 
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Old 11-21-2012, 08:18 PM   #11
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Re: Help understanding lab results..

Cloudy:

For the last few days I have been looking thru boards and papers to try to find the minimum doses of T4 and T3 that seem to get people to median/"normal" lab readings for FT4 and FT3. This is what I came up with:
100 T4 + 17.5 T3
112 T4 + 15 T3
125 T4 + 12.5 T3

Now this was a pretty crude survey, and like I say these would be minimums, lots of people take more. But it seems to me that the objective would be to take the minimum of both to get you feeling normal.

Looking at your situation now, I would say that you must be very careful interpreting your most recent labs because (1) the time was too short after the dose change and (2) it is unknown what your method of taking T4 (mixed 125 / 62.5) will do to the labs.

But looking back at the previous labs when you were on 125 + 12.5, the labs were slightly higher than median but may have still been coming down from when you were on 175 T4. So this might be a good combination for you - depending on what the RT3 looks like. Your RT3 lab you just took is going to influenced a lot by your 125+12.5 dose. If RT3 is over median I would lower the T4. I guess I would lean to less T4 and more T3.

Your current 107 + 12.5 be might be slightly low to borderline. The only way to find out would be to stick it out so you have 4-5 weeks on that dose and get new labs. You have a fair amount of time "invested" in this experiment, so it might be worth sticking it out. It would give you another data point to help decide in the future. On the other hand it might be a bad point due to the 125/62.5 question (at least in my mind).

Or you could go to 112 + 15. Synthroid makes a 112.5 pill.

It might be an idea to stay on current dose until you get the RT3 reading, then decide the next step. You want your next move to be one you can count on taking you normal or above, so that you can give it a really long test.

Best.

 
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Old 11-28-2012, 07:34 AM   #12
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Re: Help understanding lab results..

cloudy - just wondering what the RT3 reading was?
thx

 
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Old 11-28-2012, 08:25 AM   #13
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Re: Help understanding lab results..

Hi Telus,

Thx for thinking of me. I've been waiting to reply to your last very helpful post with the results of my rT3. I strangely still have not received them. I call my dr every Friday and still nothing...

Although my cholesterol was a pass, which I'm pleasantly very happy about. Still most curious about the rT3 reading.

How long do your rT3 results take to come back? How often do you check them?

I did increase back to 125 & 12.5 for the time being- I was feeling very off to continue. Feeling much better but still showing hyper and hypo systems.

I also now believe my rT3 will be excessively high. Do you think once on a proper dosage and after many months my levels (rT3) will be brought back into balance or will I need to strictly take T3 (cytomel) and follow how others have done such, with the "Wilson's syndrome"?

I have monitored my body temps before and have noticed I'm always well below normal- at anytime. Every dr I spoke with including the endocrinologist talk me out of believing it was related.

Cloudy

Last edited by cloudrunner74; 11-28-2012 at 08:29 AM.

 
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Old 11-28-2012, 10:41 AM   #14
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Re: Help understanding lab results..

hello,
same thing here. you have to wait a couple of weeks. you can bet your bottom dollar that the results are hung-up in the provincial system.

I will bet tho that you will be pleasantly surprized and your RT3 will not be over the moon. My RT3 dropped from very high 2 times normal to 13% above normal in 4 weeks. Of course that is the amount in the bloodstream. I have read that it takes 12 weeks to "clear the receptors" in cells. I have not been able to verify that statement.
I think you made the right decision to go back to 125+12.5. I am still researching this aspect for myself. Maybe we are being too chintzy on the T3. However I definitely would not go to staight T3.
Yes, temps. I am monitoring them myself/with doctor. Thyroid controls your metabolism which drives your temperature. Cannot believe what your docs are saying. You should should start doing it again. If you see a little rise due to going back to 125+12.5, then that will prove to yourself that you are going in the right direction. However I found that it can take 10 to 20 days to detect a change after changing the thyroid dose. Ultimately temps might help you decide when you are at the right dose. You must be sure to use a good thermometer. Look for one that ladies use. Look to confirm procedure - "Dr. Rind BBT"
I found the same as you. Low temps and erratic. Low means low thyroid. Erratic means weak adrenal function. You had cortisol checked? You will find as much B.S. around this as there is around thyroid stuff. Anyway the gold standard here is saliva cortisol measured 4 times during the day. The provincial labs won't do it. You'd have to find a lab and pay yourself. Test may not be absolutley necessary, but you can be sure that if you have been hypothyroid for a long time, that your cortisol will not be up to snuff; maybe not out-and-out adrenal fatigue, but lower than normal. So that has to come up as well to feel good.
Ever go for acupuncture. I'm not joking. Find a Dr of Traditional Chinese Medicine who does acupunture. They can help get these other systems rolling again as you get the thyroid where it's supposed to be. I'm doing it.
hey, let's stay in touch...

 
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Old 12-17-2012, 08:55 AM   #15
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Re: Help understanding lab results..

Hi Telus,

Just got the phone call from my Dr's secretary saying my RT3 results came in and everything is all "normal". lol
I politely asked if she could make a photocopy of the report- she said she'll see what she can do... This lady is brutal!
Anyhow, on my way over now, so standby...

 
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